Background: Refractory or relapsing Hodgkin's disease is associated with a
poor prognosis. There is no widely accepted salvage chemotherapy regimen fo
r these patients. However, the addition of high-dose chemotherapy followed
by autologous hematopoietic transplantation (AHT) has proven of benefit to
them. A prospective clinical trial was carried out to evaluate the efficacy
and toxicity of ESHAP (etoposide, methylprednisolone, high-dose cytarabine
, and cisplatin).
Patients and methods: Twenty-two patients with refractory (5) or relapsing
Hodgkin's disease (17) were entered and scheduled to receive three courses
of ESHAP. Patients suitable for AHT were then given high-dose chemotherapy
with CBV (cyclophosphamide, carmustine, and etoposide) plus AHT, whereas re
sponding, non-AHT-suitable patients completed six ESHAP courses.
Results: Nine patients achieved complete responses and seven partial respon
ses (overall response rate 73%) with ESHAP. Grade 3-4 myelotoxicity was see
n in 13 patients (59%). Nine patients received CBV plus AHT. At a median fo
llow-up time of 50 months (range 6-96), seven patients (32%) are alive and
disease-free. Three patients died of toxic effects of ESHAP (1) or CBV (2).
Actuarial overall survival and disease-free survival were 35% and 27% at t
hree years.
Conclusions: ESHAP is an active regimen for relapsing Hodgkin's disease, wi
th myelosuppression as its dose-limiting toxicity. An increased risk of tre
atment-related mortality when it is combined with high-dose chemotherapy ca
n not be ruled out.